| NPI | 1508356544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 13856506) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD496148) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2026-07-21 |